Provider Demographics
NPI:1346399706
Name:FAMILY MEDICAL & URGENT CARE CENTER
Entity Type:Organization
Organization Name:FAMILY MEDICAL & URGENT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-691-3100
Mailing Address - Street 1:1140 SW 104TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2992
Mailing Address - Country:US
Mailing Address - Phone:405-691-3100
Mailing Address - Fax:405-691-3106
Practice Address - Street 1:1140 SW 104TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2992
Practice Address - Country:US
Practice Address - Phone:405-691-3100
Practice Address - Fax:405-691-3106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty